HomeMy WebLinkAboutAge_Strunkae•"'°o� AFFIDAVIT OF PERSON, 65 YEARS OF AGE OR MORE,
:�; REQUESTING DEDUCTION FROM ASSESSED
VALUATION State Form 43708 (1-90) Prescribed by the
��°�• State Board of Tax Commissioners
Instructions for filing:
To be filed in person or. by mail with the County Auditor of the County where the
property is tocated during the 12 months before May 11 of the year the deduction
is to be effective. Deductions for mobile homes not assessed as real property
must file between January 15 and March 31. See reverse for additional instructions
and qualificatioris.
Applicant
Is applicant th��or If no, what is his/h�r �xact share
equitable owner? yes ❑ no interest? `�
If name on record is different than that of applicant, indicate below:
County Township Year
C� 9
File Mark
FI�,�I� .
!APR $ 01996
If owned with someone other than
spouse., indicate with whom.
Name of contract seller (Applicant must have been bu g on contract at least one (1) year.)
-� %
Address of contract seller � �1 � � ,. _ �-�� ^ q
���ruJ � � o` %- / %
Is the real property used afn� ccupied primarily
for his/her residence? �lyes O no
Was the applicant 65 years of age or more on
Dece r 31 of the year prior to the current year?
es O no
Does the combined annual adjusted gross
income of the appli t and any individuals
sharing owner exceed $15,000?
O yes o
Have you filed for any other deductions?
Have you filed for any deductions in any other county?
-(J'U � Page No.
Assessed
— � - �. � � � �
ApplicanYs
�
'y��o
If filed by a surviving, unmarried spouse, what was the
spouse's age at the time of death?
Source of income Amount of income
Q.�h : 4�1.1��0 / MC, . � 6 7 r• f� �
yes,
Total
If yes, what county?
I/We certify under penalty of perjury that the above and foregoing information is true and correct and that the appli-
cant was a resident of indiana and owner of the aforementioned orooertv on March 1. 19
Address of Applicarit �
���5 ��;�. �
Authorized Representative (by executed Power of Attorney)
Address of